Belmir H. et al., 2020: Pseudoaneurysm of external iliac artery after extracorporeal shock wave lithotripsy revealing Behçet disease
Belmir H, Azghari A, Sedki N.J.
Department of Vascular Surgery, Mohammed VI University of Health Sciences, Casablanca, Morocco.
Department of Vascular Surgery, Mohammed V University, Rabat, Morocco.
Department of Vascular Surgery, Cheikh Zaid Hospital, Rabat, Morocco.
Extracorporeal shock wave lithotripsy (ESWL) can lead to rare but severe arterial complications. The causal relationship of ESWL with arterial pseudoaneurysm formation in a patient with Behçet disease is discussed. A 35-year-old man presented with acute recrudescence of right flank pain caused by ureteral lithiasis immediately after having undergone a last session of ESWL. Abdominal examination revealed a painful pulsatile mass in the right iliac region. Contrast-enhanced computed tomography identified a pseudoaneurysm of the right external iliac artery in a patient with a medical history of Behçet disease. The pseudoaneurysm was treated endovascularly, including the use of a covered stent with intensive immunosuppressive therapy. We obtained successful exclusion of the pseudoaneurysm. This case highlights that arterial pseudoaneurysm may occur after ESWL in patients with Behçet disease. Strict follow-up after ESWL sessions is necessary.
Vasc Surg Cases Innov Tech. 2020 Jul 28;6(3):473-477. doi: 10.1016/j.jvscit.2020.07.003. eCollection 2020 Sep. PMID: 32923751. FREE ARTICLE
The story is a bit weird. “Symptoms arose 2 years ago with repeated attacks of right renal colic caused by ureteral lithiasis. The patient had four sessions of ESWL within 4 months to treat two right proximal and distal ureteral stones inal region, associated with difficulty in walking” An accompanying computed tomography (CT) angiography shows the stone above the iliac crest app. 15 cm away from the aneurysm of the right external iliac artery.
Aneurysms develop spontaneously in Behçet disease. The iliac aneurysm could have developed earlier without having been recognized because no CT had been done to evaluate the stones.